Choosing the right Dental Insurance

Almost all of us have had a toothache or two from time to time. While younger we may not have thought much about it but now we have found out the hard way how much a toothache costs. Dental work is not affordable but fortunately there is an option, dental insurance.

Everyone recognizes the need for medical insurance to ensure access to good health care, but too often people overlook, or just cannot afford, regular check-ups and early treatment. However, when you wait until a dental problem is serious, it’s bound to cost you more both in terms of dollars and your oral health.

The first step to avoiding costly dental bills is to start seeing a dentist regularly. Of course that costs money hence the vicious cycle.

There is an affordable choice to paying out of your pocket and that is dental insurance. Dental insurance provides you with an effective way to manage the rising costs of dental care, and it removes many of the excuses we all come up with for why not to see a dentist.

Dental plans usually cover a wide range of services.

These include preventive care, emergency care, and procedures such as crowns, root canals, periodontics, orthodontics, oral surgery, and more.

Dental plans either pay a fixed amount for a particular procedure or a percentage of the cost. While dental insurance does cover the majority of the costs of dental work you are normally required to pay a modest annual deductible for all but preventive, diagnostic, or basic types of services. Dental plans often have an annual, and sometimes even a lifetime, maximum benefit.

In shopping for dental insurance, as with any insurance, it is important to compare not only rates, but also the level of benefits offered and what the plan is designed to cover. Most dental coverage is designed to ensure that the patient receives regular preventive care. Because most dental disease is preventable, dental benefits plans are structured to encourage patients to get the regular, routine care so vital to preventing and diagnosing the onset of serious disease.

When considering dental plan options, the following factors differentiate one plan from another:

1. The type of third parties responsible for funding and administration of the plan.
2. The alternatives offered for selecting a dentist.
3. The structure used to compensate the dentist for services provided.

Understanding these differences is essential to making an informed decision when selecting a plan and using the benefits.

1. Third Parties
Regardless of the dental benefits plan, there are usually three parties involved: you, the patient; the dentist providing care; and a third party with whom you or your employer contracts for coverage. If your options include a plan funded by your employer, you may have an administrator responsible for processing and payment of claims. The primary responsibility of the third party is to provide the financial foundation for your dental benefits plan.

2. Choosing a Dentist
Dental benefits plans can be categorized by the options offered for selecting a dentist. Some plans allow you the freedom to choose your own dentist, while others, in exchange for lower rates, limit your choice. These two alternatives are called open and closed panel plans.

Open Panel. This type of dental benefits plan allows covered patients to receive care from any dentist and allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans.

Closed Panel. This type of plan allows covered patients to receive care only from dentists who have signed a contract of participation with the third party. The third party contracts with a certain percentage of dentists within a particular geographic area. There are two types of closed panel plans.

3. Paying the Dentist
Dental plans can be categorized into three types based on the compensation and treatment provided.

Indemnity Plans.
This type of plan pays the dentist on a traditional fee-for-service basis. The patient or the employer pays a monthly premium to an insurance carrier, which directly reimburses the dentist for the services provided. Insurance companies usually pay between 50 percent and 80 percent of the dentist’s fee for covered services while the remaining 20 percent to 50 percent is paid by the patient.

Capitation Plans.
This type of plan provides comprehensive dental care to enrolled patients through designated provider dentists. A Dental Health Maintenance Organization (DHMO) is a common example of a Capitation plan. The dentist is paid on a per capita basis rather than for actual treatment provided. Participating dentists receive a fixed monthly fee based on the number of patients assigned to the office. In addition to premiums, patient co-payments may be required for each visit.

Direct Reimbursement Plans.
Under this self-funded plan, an employer or company sponsor pays for dental care with its own funds, rather than paying premiums to an insurance carrier or third party. The patient pays the dentist directly and, once furnished with a receipt showing payment and services received, the employer reimburses the employee a fixed percentage of the dental care costs. The plan may limit the amount of dollars an employee can spend on dental care within a given year, but often places no limit on services provided. Patients can select a dentist of their choice and, in conjunction with the dentists, can play an active role in planning the treatment most appropriate and affordable to ensure optimum oral health.

To take full advantage of your dental benefits plan, visit the dentist regularly and get the preventive care that will keep your mouth healthy. Follow the treatment plan you and your dentist have developed. Do your dental homework, brush and floss regularly and maintain a regular schedule of oral examinations and teeth cleanings.